Diagnostic Value of Contrast-Enhanced Ultrasound in a 12-Year-Old Girl with Suspected Malposition of a Bladder Catheter and Ambiguous Findings on B-Mode Ultrasound – A Case Report

Introduction

About 25 % of all inpatients in the United States are catheterized during their hospital stay (ML Metersky. American Journal of Infection Control 2017; 45: 901 – 904). According to the latest guidelines from the American Association of Pediatrics, transurethral bladder catheterization (TUBC) is the preferred method for urine collection in young patients presenting with urinary tract infections (UTI) (EC Michael. The Journal of Pediatrics 2017; S0022 – 3476(17)30 934 – 4). Although bladder catheter insertion is a common procedure, it bears potential risks, including catheter-associated urinary tract infection (CAUTI), urethral trauma, bleeding, bladder perforation or catheter malposition (KR Wagner. Current Urology Report 2016; 17(11): 82). In case of malposition of the bladder catheter, anatomic anomalies like an ectopic ureter should be ruled out as a potential cause of UTI. Ectopic ureter defines the ureteral orifice inferior to the normal insertion on the trigone of the bladder, and further diagnostic workup ranges from ultrasonography, voiding cystourethrography, nuclear cystography and echo-enhanced cystosonography to computed-tomography (CT) and magnetic resonance imaging (MRI) in unclear cases (M. Tang et al. Canadian Urological Association journal 2015; 9: E554-E558). However, the latter imaging modalities require radiation exposure (CT) or the necessity of sedation in infants and neonates (MRI).